Give us a call or drop by anytime, we endeavour to answer all enquiries within 24 hours on business days.
Your Name Your Email Mobile Number Address Date of Birth How did you hear about us? Please be specific.
Are you interested in being an in-person patient or would you be participating as a virtual/distance patient? In PersonVirtual/Distance
Would you like an in-person or virtual (telemedicine) consultation? In PersonVirtual
What are the main health concerns that are bringing you to BioHealth/Dr. Siegel? Please include any information regarding how long you've been dealing with each health struggle, what you've done to try to resolve it, etc. Please be specific.
What is the best day and time for a consultation?
How familiar are you with a more holistic approach to health & wellness? Not at allSomewhatVery
If we could help improve or resolve your health struggles, what difference would that make in your life?
Do you have a supportive spouse, partner, friend, parent, etc who will be supporting your journey? YesNoSomewhat
Most people's health struggles are chronic and therefore, require time for change and stabilization to occur. Dr. Siegel's method of testing & treatment provides profound results for patients, however, Dr. Siegel has found for most people, a 9+ month period of time is required to create a reasonable degree of stabilization. Stabilization means improved feeling and function. In most cases monthly visits are required. I understand
How willing and able are you to commit to a treatment program of 9+ months? Not Very Willing & AbleSomewhat Willing & AbleVery Willing & Able
In order for us to have complete flexibility with how we care for our patients, we do not participate in insurance. However, we do offer various cost effective payment options. I understand
While Dr. Siegel wishes he could help all people who seek his expertise, he is only able to accept those who are ready, willing and able to commit to the healing process and his treatment recommendations.* I understand
Have you watched the pre-consult video above? Yes, I have watched the pre-consult video in full before submitting this form.